For a Human-Centered AI

“Risk Management in Healthcare Forum”: the vanished border

December 7, 2018

"A journey with new eyes. Healthcare professionals and citizens meet through the enabling technologies and a functional organization." This is the title of the meeting organized by TrentinoSalute4.0 on November 30, 2018, as part of the event that was held in Florence

In Florence, on the occasion of the 13th “Risk Management in Healthcare Forum”, we talked about a journey with new eyes in one of the domains that is most dear to each of us: health.

Journalist Elisabetta Curzel moderated the works, introducing the session as follows: “The inspiration for the title comes from a book -” La frontiera scomparsa” (the vanished border) – written by Luis Sepúlveda, a well-known Chilean author. In his autobiographical book, Sepúlveda tells of a double journey. On the one hand, there is a physical journey across Latin America; on the other, there is an inner journey, undertaken to answer the great questions of man and to find his inner self. In both journeys there is a border that is perceived, but has now disappeared”. And how does this reasoning reconciles with the healthcare world? “Simply looking at the real world” – Curzel went on – “composed of data, of devices we wear every day (the so-called wearables) and allow us not only to buy and receive items with a click, as in the case of Amazon, but which also transform people into a continuous source of information. Thanks to these devices and to the apps that we have installed on the phone, we can tell the digital world that is listening to us where we are or how many miles we have traveled in our daily activities, and post our every action on social networks in real time. We can select the ideal partner, buy food, clothes or grocery at e-commerce websites and have them delivered to our homes in less than 24 hours. No more mediators, no mediation”.

What’s happened? In all these areas – but there are many more in our everyday lives – we see a cut in physical distances. Through the intermediation of the digital, physical distances are rethought, and perceived in a new way. The times when there was a patient who went to the doctor’s, described their symptoms and waited for a diagnosis are gone for most of the population. Today, we go the doctor’s office taking with us a series of data – and very often even hypotheses of diagnosis that we think are well founded.

Can a radical technological upgrade of the health system suffice? Apparently not. And the speakers, professionals and experts belonging to different sectors, who enriched the vision of the “journey with new eyes” and took turns at the table in the first part of the working session, have explained this in detail.

The current scenario is a steady and relentless aging of the population and an increase in chronic diseases. Also, we are witnessing a strong and worrisome decrease in the number of physicians and nurses. Institutions often do not equip themselves to face a change that is already taking place. So: is it possible to create a system that puts citizens and health services in touch in a direct, instant and flexible way? Is it possible to compare the paradigms followed by Amazon with those that should be followed by healthcare?

The session – the “journey with new eyes” – was opened by Mario Del Vecchio, associate professor at the Department of Experimental and Clinical Medicine of the University of Florence, as well as director of the Osservatorio Consumi privati in sanità at the Bocconi University of Milan.

His talk, dedicated to “Demography and sustainability of the NHS” had as subtitle “A monotonous sunset”: an expression that indicates the exhaustion of the day, but also of a social security and healthcare system.

After him, Andrea Pagnin, with a background in economics, with research and teaching in economics experience – currently Business Strategist and Developer at Genoa-based IIT’s ICUB Facility. His talk – “Technology support to health companies” – had the subtitle “The reflection of the sun” – where the glows of the day also represent the expectations and hopes for a better future, and the euphoria of new technology.

And then Claudio Saccavini, technical director of Arsenàl, the voluntary consortium of the nine healthcare companies, two hospitals, the Veneto Oncology Institute and the Zero Company of the Veneto Region. How can healthcare companies construe the dynamics and developments of technology, taking into account the profound social changes taking place and future ones? And how can they intercept and support citizens on his first mile to health services? Saccavini’s talk – “Technology support to health companies” – had as subtitle “The metallic structure” – suggesting that current healthcare is sometimes too heavy and hard to access, and requires greater agility and usability.

Finally, it was the turn of Claudio Dario, Director of the Autonomous Province of Trento Agency for Healthcare Services, a longstanding promoter of innovation in healthcare. In the course of his professional development, Dr. Dario has always tried to apply changes that are gradual from the organizational point of view, to help companies achieve better management performance and better quality, efficiency and effectiveness in services to people. He had the task of offering some reflections in conncetion with the title of the session. Is it the healthcare system that must understand what steps are citizens taking, or are citizen, through the new tools, who must be able to cross and find health? Title of his talk: “Physical dis-intermediation and digital de-intermediation”. Subtitle: “The vanished border”. If the border, the customs, the desk that we used to attend no longer exist – what is the scenario to be reckoned with?

With the evolution of the Internet and digital technologies, many intermediary structures – wholesalers, retail goods and services suppliers – which have revolutionized organizational models, have disappeared. “This” – Claudio Dario pointed out – “is the aspect of the “vanished frontier“: there are no roles so markedly distinct between service users and service providers, as there is not such a marked role difference between patients and physicians or healthcare providers. In the social, organizational, relational and cultural dynamics of our society, access to information is rapid, ubiquitous and all-encompassing. Patients assess the ways in which their needs are met not so much when they are ill, but as citizens. We expect fast solutions, even in terms of services. We must therefore be able to meet these needs rapidly through the tools available to them, i.e. through a plethora of channels, but mainly through mobile devices. Hence, it is not the patient becoming “impatient”, but it is necessary to make what in logistics is defined as the “first mile” of the citizen, i.e. what steps citizens take to find a solution to their needs, meet with the “last mile” in the healthcare system, i.e. how the organization manages to provide the services”.

The second part of the morning was dedicated to a lively round table discussion that, in addition to the previously mentioned speakers, relied on the contributions of two interlocutors, Massimo Annicchiarico and Roberto Bernabei.

Dr. Annichiarico obtained his medicine degree from and specialized in internal medicine and cardiology at the University of Bologna. He then completed his managerial training at SDA Bocconi. He was Director of the Emergency Department for eight years and, for the subsequent seven years, Health Director of the AUSL of Bologna, until February 2015. Since March 2015 he has been General Director of the Ausl of Modena.

The public (which for the occasion was also connected livestream on the YouTube channel of TrentinoSalute4.0) asked speakers several questions, including this: “Is it possible to compare a standard commercial service with a healthcare service?”. “The secret is contamination. The more we become contaminated with things that are apparently different from us” – Annichiarico said – “the more chances we get to see the world with the complexity it actually characterizes it. The world is stratified, it is a complex and diversified system. And the public health service reproduces, in many aspects, the differentiation that exists in society. There is no right answer. There is an interrelation that originates between the dynamic relationship between society and services. One mutates strongly when the other changes. The problem is: to what extent is what we can rely on today able to build a laboratory for a society in which we should act?”.

The other guest of the round table discussion was Prof. Bernabei, Professor of Internal Medicine at the Catholic University and Director of the Department of Aging, Neuroscience, Head-Neck and Orthopedics at the Gemelli Hospital in Rome, and president of Italia Longeva, the network dedicated to aging created by the Ministry of Health.

To the question “What is the relationship between the elderly and digital technologies?”, Bernabei replied: “The problem is that older people should not be perceived more as such. If it is true that the population is aging, it is true that we need to rethink the over 65s, the baby boomers, with whom the relationship with digital technologies is total. And, as usual, there is a delay in politics and decision-makers who never make this kind of consideration “.

Other questions of the public: “How to support professionals of today and tomorrow?”. “Today we have widened our gaze” – concluded Claudio Dario. “The speakers of today’s meeting have pointed out how doctors should not only see themselves in the professional dimension only and should not think of themselves as being strangers to this social context and these dynamics. Otherwise we will come to a point where people will not be able to recognize the value that exists within the organization, the value they receive. The reflection must start from here.  An important reflection: it is extremely urgent to interface with citizens, we must help them navigate complex situations, in a territory that has no borders and that, not being so well marked, risks not having explicit rules. Changes will occur anyway and there will be a natural evolution of organizations and professional dimensions. In the end, we should begin to focus our attention on this relationship with citizens, to this frontier that no longer exists, and try to be present there, so as not to fall behind letting the market, that different technological solutions, pervade the professional as well as the organizational dimensions. How?  It is necessary to be able to speak with a language that can be easily unerstood, addressing the whole population”.

Many ideas have arisen from this meeting. We do not have here the space to share with you the whole debate, so, for further information, please follow this link to our YouTube channel where you can review the session recordings.

First part: from minute 00: 00 ‘: 00’ ‘to 1h: 46’: 00 ”

Second part (round table): from minute 1h: 49 ‘: 00’ ‘

Participation in the TrentinoSalute4.0 in Florence for the “13th Risk Management in Healthcare Forum” concludes the 2018 road show with which the Competence Center on Digital Health has introduced itself to some of the most significant Italian scientific communities in the industry. (m.l./e.c.)

[VIDEO] TrentinoSalute4.0: our 2018 road show 

[VIDEO] Interview with Claudio Dario, health director of APSS Trento (description of work session):

[VIDEO] Il paziente è sempre più “impaziente”? Risponde Claudio Dario, direttore sanitario APSS Trento:

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